The latest medical research on General Practice (Family Medicine)

The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about general practice (family medicine) gathered by our medical AI research bot.

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The influence of training experiences on career intentions of the future GP workforce: a qualitative study of new GPs in England.

Br J Gen

The capacity of the UK GP workforce has not kept pace with increasing primary care workloads. Although many doctors successfully complete GP specialty training programmes, some do not progress to work in NHS general practice.

This article explores the training experiences and perceptions of newly qualified GPs to understand how their education, training, and early experiences of work influence their career plans.

Participants across England were recruited through training programmes, First5 groups, and publicity using social media and networks. Open narrative interviews were conducted with individuals and focus groups. Audiorecorded interviews were transcribed, and a thematic analysis was supported by NVivo and situational analysis mapping techniques.

Fifteen participants engaged in individual interviews and 10 focus groups were carried out with a total of 63 participants. Most doctors reported that training programmes had prepared them to deal confidently with most aspects of routine clinical GP work. However, they felt underprepared for the additional roles of running a practice and in their understanding of wider NHS organisational structures. Doctors wished to avoid unacceptably heavy workloads and voiced concerns about the longer-term sustainability of general practice.

Strategies to attract and retain enough GPs to support delivery of comprehensive primary care should consider how doctors' early career experiences influence their career intentions. A coherent plan is needed to improve their preparation and increase confidence that they can achieve a professionally satisfying, effective, and sustainable career in NHS general practice.

Encounters for foot and ankle pain in UK primary care: a population-based cohort study of CPRD data.

Br J Gen

Older patients who have foot pain report variation in access to services to manage their foot health. To plan services it is essential to understand the scale and burden of foot pain that exists for GPs.

To provide UK-wide population-level data of the frequency of foot and/or ankle pain encounters recorded in general practice.

All CPRD data were collected prospectively by participating GPs. The primary outcome was prevalence of GP encounters for foot and/or ankle pain, stratified by age, sex, and different subgroups of causes.

A foot and/or ankle pain encounter was recorded for 346 067 patients, and there was a total of 567 095 recorded encounters (mean per person 1.6, standard deviation [SD] 1.3). The prevalence of recorded encounters of foot and/or ankle pain was 2980 per 100 000 (3%). The number of patients with a recorded encounter of foot and/or ankle pain was 1820 per 100 000 (1.8%). Foot and/or ankle pain encounters were reported across all age groups (54.4% females), with those aged 71-80 years placing the greatest burden on GPs. The most common specified referrals were to orthopaedics (n = 36 881) and physiotherapy (n = 33 987), followed by podiatry (n = 25 980).

The burden of foot and/or ankle pain encounters recorded by GPs is not insubstantial, and spans all ages, with a high proportion of referrals to orthopaedics. The authors recommend further exploration of 'first-contact practitioners' for foot and/or ankle pain in general practice to alleviate the burden on GPs.

Community Preceptor Perspectives on Recruitment and Retention: The CoPPRR Study.

Fam Med

Medical schools are increasingly challenged to recruit and retain community-based preceptors. Physicians experience various incentives and deterrents to teaching medical students while providing patient care. Self-determination theory (SDT) posits people act in response to internal and external motivations and suggests autonomy, competence, and relatedness are basic psychological needs for well-being and integrity. The applicability of SDT to explain why physicians become or remain a preceptor is uncertain. This study explores physicians' motivations for precepting medical students within the framework of SDT.

Focus groups were conducted at seven institutions chosen to represent national diversity using a semistructured interview guide based on SDT. Community-based family physicians discussed benefits and barriers to precepting. Interviews were recorded, transcribed, and coded using open codes. Thematic analysis was performed utilizing the conceptual framework of SDT emphasizing the domains of autonomy, competence, and relatedness.

Feeling competent about their medical practice and teaching skills, reporting connectedness to the institution and students, and having autonomy over their teaching increased preceptor motivation to teach. Concerns about clinical workload demands, negative teaching experiences, and institutional bureaucracy decreased motivation.

Preceptors choose to become and remain preceptors based on a combination of intrinsic motivating factors and effective external motivators. SDT appears to be a useful framework for assessing and responding to the needs of community-based family medicine preceptors and may be a useful guide for medical educators and policy makers seeking to identify and implement effective strategies to recruit and retain community preceptors to work with medical students.

Temporal Trends in Medical Student Burnout.

Fam Med

There is a paucity of longitudinal data documenting the temporal development of distress and burnout during medical school. The aim of this study was to examine trends and identify stressors associated with medical student distress over 4 years of medical education.

Medical students from the class of 2016 at a Liaison Committee on Medical Education-accredited medical school completed surveys nine times from orientation through after the residency match. Surveys included demographic variables and measured distress domains using the Medical Student Well-Being Index. The authors used Microsoft Excel to calculate the proportion of students screening positive for individual distress domains at each of the nine acquisition periods for descriptive analysis.

Students completed 886 total surveys for an 85% response rate, which was relatively consistent across collection periods. Medical student distress and burnout increased from two (2%) to 12 (12%) respondents and from 19 (17%) to 37 (38%) respondents, respectively, from matriculation through after the residency match (P<0.01). Depersonalization increased from 15 (13%) to 34 (35%) respondents and emotional exhaustion increased from six (5%) to 22 (22%) respondents across 4 years of medical education (P<0.01). Emotional exhaustion peaked after medical school year 1, at 37 (45%), and year 3, at 45 (44%) respondents, with improvement after summer break and residency match.

The results supported the literature demonstrating the development of burnout during medical school. Depersonalization increased early in the education process with minimal regression after development. Emotional exhaustion demonstrated a surprising increase after exposure to clinical clerkships. Further studies could support or refute the universality of these trends and evaluate prevention and intervention efforts targeting these key inflection points.

The Emergence of Family Medicine Identity Among First-Year Residents: A Qualitative Study.

Fam Med

As part of a national pilot, the Lehigh Valley Family Medicine Residency Program implemented curricular changes to emphasize family medicine identity. These changes included limiting first-year inpatient experiences, adding "interval" outpatient weeks, and increasing family physician mentorship. This study explores how postgraduate learners describe their professional identities within the context of their chosen specialty, as defined by Family Medicine for America's Health (FMAHealth).

This qualitative study approached family medicine identity formation from a social constructionist framework using evolved grounded theory. We performed a thematic analysis of focus groups conducted over 12 years with first-year residents (n=73). Then, utilizing a matrix analysis, articulations about professional identity were compared with structural components of the FMAHealth definition of the specialty. Three cohort groups (Preimplementation, Implementation, and Postimplementation) were defined to conduct a longitudinal comparison.

Six unique biosketches synthesizing the analyses emerged. Expansion in ability to articulate professional identity was evident not only across, but also within cohort groups. The Preimplementation cohort entered and left their first year identifying as relationship-centered generalists desiring guidance from role models. The Implementation learners used more FMAHealth language to describe their practice, later recognizing the potential it held for patient care. Similarly, the Postimplementation cohort entered with a broader view of family medicine and exited wondering how to help advance its reach.

Curricular changes placing interns within specialty-relevant learning settings coincide with thematic differences in articulations in professional identity. These findings suggest that experiential learning and role modeling contribute to professional identity formation among graduate medical learners.

Impact of a Student-Run Clinic on Emergency Department Utilization.

Fam Med

Student-run clinics (SRCs) provide primary care access to low-income patients who would otherwise pursue more expensive care, such as visits to emergency departments (ED). Decreasing inappropriate ED utilization offers an opportunity to create value in the health care system. However, to date, no SRC has rigorously studied this. This study examines whether increased access to ambulatory care through an SRC, the Crimson Care Collaborative (CCC), is associated with decreased ED utilization, providing value to payers and providers, and justifying investment in SRCs.

We conducted a 5-year retrospective analysis of 796 patients to determine if ED utilization changed after patients enrolled in CCC. We used patient-level ED visit data to estimate the average change in ED utilization. A regression analysis examined the impact of demographic and clinical variables on changes in ED utilization.

Average per-patient ED utilization significantly (P<0.001) decreased by 23%, 50%, and 48% for patients enrolling in CCC from 2013 to 2015, respectively. Following enrollment in CCC, average ED utilization decreased by 0.39 visits per patient per year. This translates to 62.01 avoided ED visits annually, and estimated payer savings of $84,148, representing 68% of the clinic's direct operating costs.

CCC created value to payers and providers from 2013-2015 by providing a lower-cost source of care and increasing ED capacity for more emergent and appropriate care. This study suggests that SRCs can create financial value for both payers and providers while also providing an avenue to teach value-based care in medical education.

Family Medicine Residents' Attitudes About Training in Ethiopia and the United States.

Fam Med

In Ethiopia, family medicine began in 2013. The objective of this study was to compare family medicine residents' attitudes about training in Ethiopia with those at a program in the United States.

Family medicine residents at Addis Ababa University in Addis Ababa, Ethiopia and the University of Maryland in Baltimore, Maryland completed a 43-item Likert scale survey in 2017. The survey assessed residents' attitudes about residency education, patient care, independence as family physicians, finances, impact of residency on personal life, and women's issues. We calculated descriptive statistics on the demographics data and analyzed survey responses using a two-sample t-test.

A total of 18 (75%) Ethiopian residents and 18 (60%) US residents completed the survey (n=36). The Ethiopian residents had a wider age distribution (25-50 years) than the US residents (25-34 years). More US residents were female (72%) compared to the Ethiopian cohort (50%), while more Ethiopian residents were married (72%) compared to the US cohort (47%). There were statistically significant differences in attitudes toward patient care (P=0.005) and finances (P<0.001), differences approaching significance in attitudes toward residency education, and no significant differences in independence as family physicians, the impact of residency on personal life, and women's issues in family medicine.

Across two very different cultures, resident attitudes about independence as family physicians, the impact of residency on personal life and women's issues, were largely similar, while cross-national differences in attitudes were found relative to residency education, patient care, and finances.

A Comparison of Rural and Academic Training Environments for Third-Year Medical Students on a Family Medicine Rotation.

Fam Med

Medical students have been training in rural environments for many years. However, there is sparse research demonstrating that training in a rural environment provides an equivalent learning experience to training in an academic medical setting. This study addresses that gap by comparing student performance after training in rural or community environment versus an academic setting while completing the family medicine clerkship.

Participants in this retrospective cohort study were students who completed an 8-week family medicine third-year clerkship between 2013 and 2016. Half spent the first 4 weeks in a rural or community setting while the other half were in an academic setting. These placements were reversed after midterm exams. Data were collected from both student academic files and from rural rotation tracking systems at two time points: midterm and following the 8-week rotation.

Results from our sample of 159 medical students (89 [56.0%] male and 70 [44.0%] female) revealed no statistically significant differences in students' midterm (P=.63) and final scores (P=.74) based on training locations.

Study findings suggest that rural and academic clerkships provide equivalent levels of knowledge for family medicine students. This finding has particular relevance for students whose intent is to practice in a rural location. Additional research is needed to identify if these findings are generalizable to other medical schools and locations.

Teaching Opioid Tapering Through Guided Instruction.

Fam Med

Given the current opioid epidemic, national practice guidelines and many state laws are shifting the treatment paradigm for chronic, noncancer pain to a judicious use of opioids. This has prompted a need to teach family medicine residents how to appropriately taper opioids. We created a multifaceted approach to integrate teaching of opioid tapering into a family medicine curriculum with an emphasis on guided instruction. We assessed the degree to which this curriculum affected guideline-concordant opioid prescribing within the family medicine practice.

A retrospective chart review of 707 patients on chronic opioid therapy (COT) for noncancer pain was conducted before and after the incorporation of a guided instruction experience to the residency curriculum. The primary outcomes included the number of patients on chronic opioids, the average morphine equivalent daily (MED) per patient, the percentage of patients on >50 MED or >90 MED, and the number of patients on concomitant benzodiazepines.

Of the original 707 patients, 188 tapered off COT. Of those remaining on COT, the average MED did not change (53.4±76.9 vs 58.5+89.1, P=0.053). The percentage of patients on >50 MED and >90 MED decreased significantly (30.6% vs 25.0%, P=0.001; 19.4% vs 14.0%, P=0.027). The total number of patients on concomitant benzodiazepine decreased from 212 to 131.

Providing opportunities for guided instruction with opioid tapering allowed for an increased concordance with national practice guidelines.

Comparison of Vitex agnus-castus Extracts with Placebo in Reducing Menopausal Symptoms: A Randomized Double-Blind Study.

Korean J Fam

Menopausal symptoms have remarkable negative effects on women's quality of life, justifying the need to assess various therapeutic options. This research aimed to determine the effectiveness of Vitex agnus-castus extracts in alleviating menopausal symptoms in comparison with that of placebo.

This study was a randomized controlled double-blind clinical trial with a study group of 52 women referred to a clinic in Kermanshah in 2017. The participants were randomly divided into two groups: Vitex group (26 subjects) and placebo group (26 subjects). Menopausal symptoms were assessed using the Greene Scale before and 8 weeks after the intervention.

After the intervention, the mean scores for total menopausal disorder, anxiety, and vasomotor dysfunction were significantly lower in the Vitex group than in the placebo group (P<0.05). The mean scores of the variables of somatic complications, depression, and sexual dysfunction did not show significant differences between the Vitex and placebo groups (P>0.05).

Administration of Vitex agnus-castus extracts as a phytoestrogenic medicine can alleviate menopausal symptoms in women.

The Association between Obesity Phenotypes and Early Renal Function Decline in Adults without Hypertension, Dyslipidemia, and Diabetes.

Korean J Fam

The prevalence of chronic kidney disease is increasing worldwide. Several studies have suggested that obesity is associated with early renal dysfunction. However, little is known about the relationship between obesity phenotypes and early renal function decline. Therefore, this study aimed to identify the relationship between obesity phenotypes and early renal function decline in adults without hypertension, dyslipidemia, and diabetes.

We conducted a cross-sectional analysis of clinical and anthropometric data from 1,219 patients who underwent a routine health checkup in 2014. We excluded adults with cardiovascular disease, renal disease, diabetes, hypertension, dyslipidemia, or low glomerular filtration rate (<60 mL/min/1.73 m2). Renal function was determined according to the estimated glomerular filtration rate calculated using the Chronic Kidney Disease Epidemiology Collaboration creatinine-cystatin C equation.

Age, sex, body mass index, waist circumference, triglyceride, low-density lipoprotein, and fasting glucose had an association with the estimated glomerular filtration rate. After adjusting for age, sex, smoking status, and alcohol intake, the odds ratios of the metabolically abnormal normal weight and metabolically abnormal obese phenotypes for the presence of low estimated glomerular filtration rates were 1.807 (95% confidence interval, 1.009- 3.236) and 1.834 (95% confidence interval, 1.162-2.895), compared with the metabolically healthy normal weight phenotype. However, the metabolically healthy obese phenotype did not show a significant association with early renal function decline.

In this cross-sectional study, we confirmed the association between the metabolically abnormal normal weight and metabolically abnormal obese phenotypes and early kidney function decline in adults without hypertension, dyslipidemia, and diabetes.

Continuity of care for patients with chronic conditions from rural or remote Australia: A systematic review.

Aust J Rural

To identify the barriers and facilitators of achieving continuity of care between health services for patients with chronic conditions living in regional, rural and remote Australia.

Facilitators and barriers of continuity of care for non-metropolitan patients with a chronic condition.

Initially, 536 studies were included in the review. Of these, 12 studies were found to have met the eligibility criteria and were included in the final analysis.

Coordination of health care services for non-metropolitan patients with chronic conditions substantially improves the outcomes for patients. Overall, communication, availability of resources and location are the major barriers and facilitators to continuity of care, depending on how they are managed. Recommendations have been provided to assist practitioners and policy-makers to improve the experience of shared care and health outcomes for non-metropolitan patients.